Thursday, August 02, 2018

Resistant hypertension: definition and prevalence

Resistant hypertension is generally defined as uncontrolled clinic blood pressure (>140/90 mm Hg) after treatment with three or more antihypertensives. Ideally, one of the 3 agents should be a diuretic and all agents should be prescribed at optimal dose amounts.

It is estimated that 20–30% of patients treated for hypertension have uncontrolled blood pressure, however the true prevalence of resistant hypertension is estimated at 8–18%.

In the NHANES study, target blood pressure (BP) values, were achieved in only 53% of the patients treated with antihypertensive drugs. An even lower percentage of BP target levels, i.e. < 130/80 mm Hg, was observed in patients with diabetes and chronic kidney disease.

A large study based on the Spanish Ambulatory Pressure Registry covered about 68,000 patients treated for hypertension, 12% of whom were diagnosed with resistant hypertension (RH). Ambulatory blood pressure measurement (ABPM) confirmed true resistance to treatment in 62.5% of the patients, and in the remaining 37.5%, the ineffectiveness of the therapy was due to the white coat effect.

Lifestyle changes may be recommended in order to reduce overall hypertension. Patients with resistant hypertension should adhere to the same nutritional and behavioral recommendations valid for the general hypertensive population.

Therefore, weight loss should be encouraged in overweight and obese patients; smoking cessation should be promoted, together with a moderation of alcohol consumption, a reduction of sodium intake and an increase in physical activity.
Resistant hypertension: definition and prevalence
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